ReviewEuropean journal of clinical investigation2023
Flaws and uncertainties in pandemic global excess death calculations.
Review in European journal of clinical investigation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Excess mortality in Mainland China after the end of the Zero COVID policy: A systematic review.Epidemiology and infection · 2026Pooled it
- Post-pandemic mortality patterns and COVID-19 burden considering multiple death causes.European journal of epidemiology · 2026Article
- Paid and unpaid productivity losses across 28 European countries due to excess deaths and COVID-19 deaths from 2020 to 2023.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- Excess life-years and productive life-years lost in Poland through the COVID-19 pandemic and post-pandemic years.Archives of public health = Archives belges de sante publique · 2026Article
- Article
- India's death toll in 2021 during the COVID-19 pandemic: insights from delayed official civil registration data.Journal of global health · 2025Article
- Non-COVID-19 mortality among older people or with chronic conditions during year 2020 in France: a nationwide cohort study.BMC public health · 2025Article
- Excess and reduced work absence during COVID-19 in Poland: insights from cause-specific time-series models.Population health metrics · 2025Article
- Post-pandemic excess mortality of COVID-19 in Hong Kong: a retrospective study.The Lancet regional health. Western Pacific · 2025Article
- Assessing COVID-19 Mortality in Serbia's Capital: Model-Based Analysis of Excess Deaths.JMIR public health and surveillance · 2025Article
- Excess mortality during the first 2 years of the COVID-19 pandemic (2020-2021) in the Netherlands: Overall and across demographic subgroups.IJID regions · 2025Article
- Article
- Beyond death counts: how COVID-19 affected excess mortality and productive life-years lost across 28 European states, 2020-2023.Frontiers in public health · 2025Article
- Excess mortality and years of life lost from 2020 to 2023 in France: a cohort study of the overall impact of the COVID-19 pandemic on mortality.BMJ public health · 2025Article
- Mortality in Frankfurt am Main, Germany, 2020-2023: higher excess mortality during an influenza wave in 2022 than during all COVID-19 waves altogether.GMS hygiene and infection control · 2025Article
- Relationship between COVID-19 cases and monthly mortality from all causes, cancer, cardiovascular diseases and diabetes in 16 countries, 2020-21.International journal of epidemiology · 2024Article
- Differential risk of healthcare workers versus the general population during outbreak, war and pandemic crises.European journal of epidemiology · 2024Article
- Understanding excess mortality in Europe during the COVID-19 pandemic.The Lancet regional health. Europe · 2024Article
- Excess Deaths in Korea During the COVID-19 Pandemic: 2020-2022.Journal of preventive medicine and public health = Yebang Uihakhoe chi · 2024Article
- Construction and validation of a covariate-based model for district-level estimation of excess deaths due to COVID-19 in India.Journal of global health · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
Abstract
Several teams have been publishing global estimates of excess deaths during the COVID-19 pandemic. Here, we examine potential flaws and underappreciated sources of uncertainty in global excess death calculations. Adjusting for changing population age structure is essential. Otherwise, excess deaths are markedly overestimated in countries with increasingly aging populations. Adjusting for changes in other high-risk indicators, such as residence in long-term facilities, may also make a difference. Death registration is highly incomplete in most countries; completeness corrections should allow for substantial uncertainty and consider that completeness may have changed during pandemic years. Excess death estimates have high sensitivity to modelling choice. Therefore different options should be considered and the full range of results should be shown for different choices of pre-pandemic reference periods and imposed models. Any post-modelling corrections in specific countries should be guided by pre-specified rules. Modelling of all-cause mortality (ACM) in countries that have ACM data and extrapolating these models to other countries is precarious; models may lack transportability. Existing global excess death estimates underestimate the overall uncertainty that is multiplicative across diverse sources of uncertainty. Informative excess death estimates require risk stratification, including age groups and ethnic/racial strata. Data to-date suggest a death deficit among children during the pandemic and marked socioeconomic differences in deaths, widening inequalities. Finally, causal explanations require great caution in disentangling SARS-CoV-2 deaths, indirect pandemic effects and effects from measures taken. We conclude that excess deaths have many uncertainties, but globally deaths from SARS-CoV-2 may be the minority of calculated excess deaths.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.